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Vitrectomy

Old 16th Aug 2020, 12:42
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Vitrectomy

Anyone have any experience of vitrectomy surgery, in particular post operative recovery and Class 1 renewal?
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Old 16th Aug 2020, 17:07
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Originally Posted by a5in_the_sim
Anyone have any experience of vitrectomy surgery, in particular post operative recovery and Class 1 renewal?
No pilots licence or medical, but I had a vitrectomy in about 1996 following cataract surgery (early 1992), posterior capsulotomy (~1993) and detached retina (two surgeries a week apart) 6 weeks before the end of my engineering degree in early 1995. All in my dominant eye naturally.

The guy who did the vitrectomy sent me on my way with advice that all went well, that I should have no further complications, and (tongue in cheek) that I should avoid ophthalmologists in future. Twenty five years later at age 57 my vision in the affected eye is still excellent, though with zero accommodation of course due to the pseudophakic (perspex, fixed focus) lens installed to replace my natural lens in 1991.

So I can't advise regarding an aviation medical, but from an end users point of view, so to speak, recovery from vitrectomy was prompt and outcome was excellent, and I've had no further surgeries of any kind on my eyes. Yes, with the help of an excellent optometrist I met in primary school almost 50 years ago, I've avoided ophthalmologists since being told to.
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Old 16th Aug 2020, 23:29
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I can only indirectly answer the question. This is my story, and it does spell out that there's a difficult period while you wait for the ensuing cataract. Also, that air or gas is now left in the eye rather than fill it with seawater or whatever they use. I had heard that an American surgeon claims he can avoid the cataract by the way in which in introduces the water. No one I questioned had heard this and left me in no doubt I was 99.99% likely to get the cataract within a year. OR, it becomes bad enough that they will pay for the procedure. They were kind to me and got it pushed through fairly quickly. But you can see the issue. You can have fabulous vision while you're waiting. There's no reason to spend months grounded waiting for something to happen, but you will need to monitor the condition of the lens. The vitrectomy leaves a small scar off field, and will obviously have an associated waiting time to get airborne. I would have thought that would have been fairly standard.

Since most 60 to 70 year-olds get a detached vitreous, it's not altogether a bad thing to have had the operation. The membrane is so thin it used to be thought that it didn't exist. It's only attached at IIRC 7 points - one of them being near the optic nerve.

I've had a vitrectomy in both eyes, some years apart. The main problem seems to be the rapid onset of cataract after the operation.

The first operation was due to a bleed which left me with a large floater. It dangled right in the centre of vision. I'd been used to fabulous eyesight and found it very distressing. I was relieved to learn there was an escape route.

Back circa 2005, it was considered a serious operation. I had full anaesthetic and a night's stay in hospital. No one mentioned, I don't think, the cataract, and I was surprised that while in Texas, I could quite suddenly focus on the tiny chronograph numbers on my watch. This sudden change of focus is a symptom of nuclear cataract despite the clarity of the close vision being counterintuitive. Finally I had it done in a small business in Texas. They did a darn good job for about $3k

In both operations the vision was blurred but quickly coming right. This was then.

Years went by and I noticed my other eye had fingers of blurriness when I blinked. Being back in England I was able to get a referral from Spec Savers and asked for the same surgeon. It seems that sometimes the retina gets some scars on it. Possibly due to the vitreous humour's anchor points pulling on it. (my notion, they are always reluctant to enter into their science with a layman) Anyway, it seemed that there was a routine procedure called Vitrectomy and Scrape. To my astonishment I was asked if I wanted a local anaesthetic. I agreed.

I was wheeled in on a chair which reclined. A sheet was put over my face with a hole for the surgeon to work through. The anaesthetist was there for two reasons. One to inject my eye. I suspect the other was to be on standby should I throw a fit. The injection knocked my eye out cold. Same stuff a dentist uses, IIRC. I said, 'My eye doesn't work'. and he said, 'Yes, I've just de-worked it.' The surgeon took quite a while, asking for pressure changes etc., but really said very little except, 'It is coming of, but in little pieces.'. I went home the same day. Sadly, the briefing I'd got was not as thorough as the first one. I went home to be alone on a long weekend. In the morning I decided to cheat and sneak a peek out from under the patch. It was by the grace of God that I'd overheard a yacht club member mention that he could see over the top of the bubble. He'd had to lie on his face for days so the gas could support the retina. I however, was not sure what to do, but I did know the ball I could see was normal. A bedside light was crystal clear over the top edge of the bubble.

The bubble was like black chrome. Perfect and round. It got smaller every day. If it got swished, it might break into smaller bubbles like mercury and later combine. I wasn't to drive for 14 days, but after 7 days I found I could sit in my car and see everything over the wheel. I wasn't tempted.

I was due back at the hospital on the 15th day. On that morning, the last particles of bubble had been absorbed. I drove myself to hospital.

while I was waiting for the cataract phase, my vision was like a teenager's. The next cataract was a bit of a pain with edge distortion, but after fussing over a period of weeks they offered me laser treatment. The charming lady had been doing it for 14 or more years and put me at ease. I'd been really worried about lasers being zapped into my eye. On driving from the hospital, I noticed a huge improvement. She's zapped away some bits that shouldn't have been there. She also works on the lens encapsulation, which can become cloudy. In the old days, that was the end of vision, now, incredible clarity can be regained. A fabulous science.
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Old 17th Aug 2020, 05:00
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I'd forgotten about the bubble! It looks like a dark ring with a bright centre because of the way it acts like a lens. The gas dissipates at a rate proportional to the surface area, rather than the volume, so it shrinks really slowly the first few days, then faster and vanishes quite quickly.
I didn't get a cataract afterwards because I'd already had one beforehand.
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